Bright Smiles

Dental treatment can be free and it can be extremely expensive. One hospital consultant was shown a $58,000 estimate submitted to a patient for what is known as’full mouth rehabilitation’. Put in a proper context this price would be far less than this particular patient would normally pay for a new car. And in the greater scheme of things your mouth is far more valuable, and considerably less replaceable, than any car.

However, given prices at that level, it is a relief to report that the majority of UK dental treatment is still under NHS auspices. But the current method of providing these dental services is not only relatively new, it is also under intermittent threat of change, and social security and health service systems are probably at even greater risk of radical change. And at this time only 50 per cent of all dentists offer a complete NHS service, and – as most of you who live there know without us telling you – this falls dramati­cally to around 30 per cent in parts of southern England. This is because, while NHS fees are the same all over the country, nearly every single practice overhead costs more in the south.

Every new person who signs an agreement for continu­ing care is entitled to a treatment plan from the dentist explaining what treatment is needed and what it will cost, unless only minimal treatment is needed. At the time of writing, a person whose treatment is under NHS auspices will pay $4 for a check-up, just over $4 for a small filling, almost $6.50 for a simple scale and polish and instructions in oral hygiene and only just over $17 for a single-canal root-filling on an incisor. And it is worth keeping in mind that the more regularly you pay the $4 for the check-up, the less likely it is that you will have to spend consider­able amounts of money on the more expensive treat­ments at a later date. You should always pay the dentist. Although it generally takes three months’ notice for a dentist to terminate a continuing care agreement, this can be done immediately if the fees are not paid. Indeed, a dentist is entitled to ask for the entire cost of treatment at the first visit. Dentists should also arrange for out-of-hours emergency treatment for their patients on the NHS continuing care list. Some operate a cooper­ative Rota; others have come to an arrangement with the local general hospital to provide this service.

Four free treatment centers: dental teaching hospitals, general hospitals, salaried general dental practitioners and the community dental service. (The latter two generally only treat patients who would be exempt from NHS payments anyway.) In marked contrast to these is the private dental sector. Most general practice dentists will do some private work if they are asked to do so. Some, however, will do only private work, and most dentists specializing in a specific field will only work privately.

It is possible to mix NHS and private treatment in a single course of treatment. For example, a dentist may offer extractions and fillings on an NHS basis, but make the subsequent partial dentures on a private basis. However, the dentist must not only make such a pro­posal clear at the initial stages in the treatment plan, but also not intimate that certain treatments are unavailable on NHS terms, unless of course they genuinely are not available.

All private sector dentistry is based on either piece­work or the time taken to perform the treatment. The longer and more complicated the treatment the higher the cost. Some fees explicitly pay both the dentist and the technician who makes the denture, crown or bridge work. The level of fees depends on which part of the country the dentist is in. Giving a comparative example with the NHS, an incisor root filling will cost between $55 and $180, and a small filling between $18 and $60.

As with medicine and surgery, where fees are so high that they are well beyond the pockets of many people, insurance schemes have entered the market to ease the burden. However, they differ from the standard medical insurance where the consumer chooses from a list of hospitals, pays the bills and is reimbursed. Denplan, one of the older dental insurance schemes, signs up the dentists, not the patients. People opt for the scheme at their dentist, but pay their monthly premiums to Denplan, which then reimburses the dentist for work done according to which scale of fees they are on. The scale is based on the patient’s original dental condition -the worse it is the higher the monthly payment. Patients also pay any laboratory fees incurred. In effect, Denplan is less an insurance scheme than a prepayment budget scheme for continuing dental treatment (or health) where a small part of the monthly payment also buys insurance for emergency and accident cover. Other dental ‘insurance’ schemes, such as BUPA, work in the same general way. There are generally exclusions, such as prolonged orthodontic treatment for children, or im­plant work. Some ordinary medical insurance policies will pay for some dental work, notably the surgical extraction of wisdom teeth.

Payment for dental treatment abroad falls into two categories. European Union (EU) countries work with EU form Elll to offer free (not at time of use) or reduced cost emergency treatment. Most other countries do not. Form Elll can be obtained, along with an explanatory leaflet T5 ‘Health Advice for Travellers’, from post offices. This leaflet explains, in some detail, which offices to go to in each of the EU countries to collect the appropriate forms to make a claim for the reimburse­ment of dental emergency fees. It also explains what you need to take with you. Generally this will be a passport, your NHS card and the Elll form. To be frank it does not sound easy, unless you are an expert form-filler, and it has to be wondered how many people actually travel with the latter two items about their person.

The leaflet also supplies details of countries outside the EU with reciprocal health care agreements with the UK. Few of these offer dental services. The leaflet is worth keeping, however, for its wider medical care information. Most countries with some form of social­ized medicine run their basic dental services on a rebate system. You pay the dentist and then receive a per­centage rebate at a later date. This is a form of state insurance scheme. Private insurance schemes are also common in the EU. In the United States a novel scheme that puts the emphasis on prevention is run by a hand­ful of US companies for employees and ex-employees. They pay a minimum sum every six months to have a full check-up. Providing they continue to do this, all subsequent treatment is free. This is a proper preventive medical service, with a market incentive to take part.